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Changes in brain metabolism and morphology (or structure) are also associated with BPD. Borderline patients express hyperactivity in the part of the brain associated with emotionality and impulsivity (limbic areas), and decreased activity in the section that controls rational thought and regulation of emotions (the prefrontal cortex). (Similar imbalances are observed in patients suffering from depression and anxiety.) Additionally, volume changes in these parts of the brain are also associated with BPD and are correlated with these physiological changes.3

These alterations in the brain may be related to brain injury or disease. A significant percentage of borderline patients have a history of brain trauma, encephalitis, epilepsy, learning disabilities, ADHD, and pregnancy complications.4 These abnormalities are reflected in brain wave (EEG, or electroencephalogram) irregularities, metabolic dysfunction, and white and gray matter volume reductions.

Since failure to achieve healthy parent-child attachment may result in later character pathology, cognitive impairment on the part of the child and/or the parent may hinder the relationship. As the latest research strongly suggests that BPD may be at least partly inherited, parent and child may both experience dysfunction in cognitive and/or emotional connection. A poor communication fit may perpetuate the insecurities and impulse and affective defects that result in BPD.

Developmental Roots

Developmental theories on the causes of BPD focus on the delicate interactions between child and caregivers, especially during the first few years of life. The ages between eighteen and thirty months, when the child begins the struggle to gain autonomy, are particularly crucial. Some parents actively resist the child’s progression toward separation and insist instead on a controlled, exclusive, often suffocating symbiosis. At the other extreme, other parents offer only erratic parenting (or are absent) during much of the child-raising period and so fail to provide sufficient attention to, and validation for, the child’s feelings and experiences. Either extreme of parental behavior—behavioral over-control and/or emotional under-involvement—can result in the child’s failure to develop a positive, stable sense of self and may lead to a constant, intense need for attachment and chronic fears of abandonment.

In many cases the broken parent-child relationship takes the more severe form of early parental loss or prolonged, traumatic separation, or both. As with Dixie, many borderlines have an absent or psychologically disturbed father. Primary mother figures (who may sometimes be the father) tend to be erratic and depressed and have significant psychopathology themselves, often BPD. The borderline’s family background is frequently marked by incest, violence, and/or alcoholism. Many cases show an ongoing hostile or combative relationship between mother and pre-borderline child.

Object Relations Theory and Separation-Individuation in Infancy

Object relations theory, a model of infant development, emphasizes the significance of the child’s interactions with his environment, as opposed to internal psychic instincts and biological drives unconnected to sensations outside himself. According to this theory, the child’s relationships with “objects” (people and things) in his environment determines his later functioning.

The primary object relations model for the early phases of infant development was created by Margaret Mahler and colleagues. 5 They postulated that the infant’s first one to two months of life were characterized by an obliviousness to everything except himself (the autistic phase). During the next four or five months, designated the symbiotic phase, he begins to recognize others in his universe, not as separate beings, but as extensions of himself.

In the following separation-individuation period, extending through ages two to three years, the child begins to separate and disengage from the primary caregiver and begins to establish a separate sense of self. Mahler and others